Cluster of Nontoxigenic Corynebacterium diphtheriae Infective Endocarditis and Rising Background C. diphtheriae Cases-Seattle, Washington, 2020-2023.

BACKGROUND: Nontoxigenic Corynebacterium diphtheriae, often associated with wounds, can rarely cause infective endocarditis (IE). Five patients with C. diphtheriae IE were identified within 12 months at a Seattle-based hospital system. We reviewed prior C. diphtheriae-positive cultures to determine if detections had increased over time and evaluated epidemiologic trends. METHODS: We conducted a formal electronic health record search to identify all patients aged ≥18 years with C. diphtheriae detected in a clinical specimen (ie, wound, blood, sputum) between 1 September 2020 and 1 April 2023. We collected patient demographics, housing status, comorbidities, substance-use history, and level of medical care required at detection. We extracted laboratory data on susceptibilities of C. diphtheriae isolates and on other pathogens detected at the time of C. diphtheriae identification. RESULTS: Between 1 September 2020 and 1 April 2023, 44 patients (median age, 44 years) had a C. diphtheriae-positive clinical culture, with most detections occurring after March 2022. Patients were predominantly male (75%), White (66%), unstably housed (77%), and had a lifetime history of injecting drugs (75%). Most C. diphtheriae-positive cultures were polymicrobial, including wound cultures from 36 (82%) patients and blood cultures from 6 (14%) patients, not mutually exclusive. Thirty-four patients (77%), including all 5 patients with C. diphtheriae IE, required hospital admission for C. diphtheriae or a related condition. Of the 5 patients with IE, 3 died of IE and 1 from COVID-19. CONCLUSIONS: Findings suggest a high-morbidity outbreak disproportionately affecting patients who use substances and are unstably housed.

A Case Report of Human Herpesvirus-6 (HHV-6) Meningitis Masquerading as Idiopathic Intracranial Hypertension in an Immunocompetent Patient.

We present a case of a 32-year-old woman with signs and symptoms of idiopathic intracranial hypertension (IIH), but who, upon further investigation, was found to have human herpesvirus-6 (HHV-6) in both cerebrospinal fluid (CSF) and serum. This rare cause of meningitis in an immunocompetent individual and a relatively unique presentation is described along with a review of proper diagnostic workup and treatment. HHV-6 meningitis is commonly detected via molecular diagnostics and thus needs confirmatory testing of viral load of acellular compartments or viral serology. The reason for this added diagnostic step is due to the incorporation of the virus into the host DNA, leading to increased false-positive results on screening tests. In this case, proper diagnosis, treatment, and follow-up were pursued by following guidelines proposed in the literature of HHV-6 meningitis.

MAGNAMWAR: an R package for genome-wide association studies of bacterial orthologs.

Summary: Here we report on an R package for genome-wide association studies of orthologous genes in bacteria. Before using the software, orthologs from bacterial genomes or metagenomes are defined using local or online implementations of OrthoMCL. These presence-absence patterns are statistically associated with variation in user-collected phenotypes using the Mono-Associated GNotobiotic Animals Metagenome-Wide Association R package (MAGNAMWAR). Genotype-phenotype associations can be performed with several different statistical tests based on the type and distribution of the data. Availability and implementation: MAGNAMWAR is available on CRAN. Contact: john_chaston@byu.edu.